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PO Go Digit General Insurance Ltd. Schedule/Receipt

Digit Two-Wheeler Liability Only Policy
UIN No.: IRDAN158RP0003V01201718

N Name DELROY FERNANDES . Vehicle Registration No. GA03AK0192

Address H NO 5/64 MADDO VADDO , Partner Name SADDAM HUSSAIN KHAN
CALANGUTE,BARDEZ, -403516,Mapusa- 1078516
Partner Code
403507 1078516
Mobile xxxxxxxxx9195 Partner Mobile No. +919168753414
Email sxxxxxxxxxxxx1@gxxxl.com Partner Email saddamkhan2991@gmail.com

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PAN (POSP) DDGPK6742H

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Aadhar No. For Claims, contact us at 1800-258-5956

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YOUR POLICY DETAILS

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Policy No. D042819627 / 19082021 Policy Issue Date 19-Aug-2021 Invoice No. IA044778129

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From 20-Aug-2021 10:49:32

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Period of Policy Policy Term 1 Year
To 19-Aug-2022 23:59:59

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1 DD From -- Invoice 19-Aug-2021

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Period of Policy for PA Owner Driver
To -- Date

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IGS YOUR VEHICLE DETAILS

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RTO location Mapusa,GOA Make HONDA Model/Vehicle

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Variant (Sub- ACTIVA/3G

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Engine No. JF50EU6049203 Chassis No. ME4JF509LGU049171 Type)

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Body Type Scooter Fuel Type Petrol Year of Regn 2017

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Seating

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POS Capacity Cubic Capacity 110 CC Year of Mfg. --

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135.3
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ENDORSEMENT

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Invoice Number Invoice Date Gross Premium Igst Cgst 22Sgst Utgst Cess Net Premium
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IA044778129 2021-08-19 887.36 135.36 0.00 0.00 0.00 0.00 752.00
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LIABILITY PREMIUM (`)

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Basic Third-Party Liability (`) 752.00 PA cover for Owner-Driver (`) --

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PA cover for 2 unamed passengers each 0 (`) -- PA cover for Paid Driver 0 (`) --
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Legal Liability to Employees (`) -- Legal Liability to Paid Driver (`) --

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FH Net Premium (`) 752.00

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IGS IGST @ 18% = (`135.36) 135.36

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Final Premium (`) 887.36

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OTHER DETAILS
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Previous Insurer -- Previous Policy No. --

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Previous Policy
-- --
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IMT - Endorsements Expiry Date

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GSTIN/UIN No. Unregistered State Code 30

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N Receipt No. RA047105121 Receipt Date 19-Aug-2021

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Financier Details -- Nominee Details --

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Other Detials --
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Geographical Area: Any liability incurred within India shall be covered subject to Policy Terms and Conditions, unless specifically agreed and
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endorsed. Limitation as to use: The policy covers use of the vehicle for any purpose other than hire or reward, racing, pace making, reliability trial,
speed testing and use for any purpose in connection with the Motor Trade. Person or Class of persons entitled to drive: Any person including the
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insured. 1) Provided that a person driving holds a valid effective driving license at the time of the accident and is not disqualified from holding or
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obtaining such a license. 2) Provided also that the person holding a valid effective Learner’s License may also drive the vehicle and that such a
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person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989 and any subsequent amendment as applicable. Limits of
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Liability: 1) Under Section II - 1 (i) of the policy: Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor
Vehicles Act, 1988 and any subsequent amendment as applicable. 2) Under Section II - 1 (ii) of the policy: Damage to Third Party Property -
(`100000) 3) P.A. Cover for Owner Driver under Section III (CSI) -(`)(per annum).

PA Owner Driver Declaration:The Policy has been issued without Compulsory Personal Accident Cover to Owner Driver on the basis of
http your declaration that you do not hold a valid Driving License on or before the date of commencement of this Policy / already have an
alternate Personal Accident insurance cover of Rs. 15 Lakhs

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095.IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 29AACCO4128Q1ZW HSN: 997134/General Insurance Services, GSTIN Address: Go Digit General
Insurance Limited,Atlantis No 95, 4th B Cross Road 5th Block Koramangala Industrial layout,Bengaluru,Karnataka,PIN-560095
https://

PO Go Digit General Insurance Ltd. Schedule/Receipt

Digit Two-Wheeler Liability Only Policy
UIN No.: IRDAN158RP0003V01201718

Important Note: Please inform the Company in case of change on account of addition of CNG/PNG kit.

PUC Declaration:The Policy has been issued subject to valid Pollution Under Control (PUC) Certificate disclosed by you as an insured on or before
the date of commencement of the Policy .Cheque dishonor / Non-receipt of payment premium paid through Cheque, the policy is void ab-initio in
case of dishonor of Cheque or non-receipt of payment. Violation of Motor Vehicle Act: This policy is issued in accordance with the provision of
Chapter X and Chapter XI of MV act, 1988 and any subsequent amendment as applicable. Any violation will forfeit all benefits and coverages
under the Policy. The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment
made by the Company by reason of wider terms appearing in Certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from

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the insured. See the Clause headed (Avoidance Of Certain Terms And Right Of Recovery) in the policy. This policy is subject to the standard

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policy wordings, warranties and conditions applicable for this product in addition to coverages and exclusions specified in the motor vehicle tariff
published by IRDAI. Policy would be void on the ground that it was obtained by non- disclosure of material fact or by a representation of fact

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Note: The terms and conditions detailed in this policy schedule as well as the policy document sent by Digit shall prevail in case of any dispute.

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For & On Behalf of Go Digit General Insurance Ltd.

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In case of claim or any other query, please

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contact our 24-hour C all C entre at 1800-

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258-5956 or email us at hello@godigit.com Praveen Bhat

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Vice President – Customer Experience
or visit our website www.godigit.com. praveen.bhat@godigit.com

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Authorized Signatory
Printed, Signed, and Executed at Bengaluru

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Consolidated Stamp Duty has been paid as per Letter of
Authorization No.67-B/04/2017-18 Date: 30th May 2017

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issued by Department of Stamps and Registration ,
Bengaluru- 560009 - KARNATAKA.

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Hey, our document is now digitally signed

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Click here to view the certificate.

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Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095.IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 29AACCO4128Q1ZW HSN: 997134/General Insurance Services, GSTIN Address: Go Digit General
Insurance Limited,Atlantis No 95, 4th B Cross Road 5th Block Koramangala Industrial layout,Bengaluru,Karnataka,PIN-560095